MEDICARE: LIBERTY EMS SERVICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance
2	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1821418922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY EMS SERVICE LLC

Provider Business Mailing Address
First Line	:	316 FEATHERSTON ST
Second Line	:
City	:	WALDRON
State	:	AR
Zip	:	72958-8337
Country	:	US
Telephone Number	:	479-227-9888
Fax Number	:	479-542-1188

Provider Business Practice Location Address
First Line	:	316 FEATHERSTON ST
Second Line	:
City	:	WALDRON
State	:	AR
Zip	:	72958-8337
Country	:	US
Telephone Number	:	501-551-1486
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY DIIVNE
Credential	:
Telephone Number	:	501-551-1486

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	03/02/2026

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